The autonomic aspects of the post-COVID19 syndrome

Abstract

The SARS-CoV-2 outbreak, responsible for the widespread COVID-19, led to one of the most rogue pandemics in modern time, yet the major effects of the pandemic may still be ahead of us. SARS-CoV-2 had been found to possess autoimmune properties. Close to 20 distinct autoantibodies which target GPCR of the nervous system and renin-angiotensin system-related molecules were found significantly associated with the clinical severity of COVID-19. The new on-set of more than 10 various autoimmune disorders were documented as well. Additionally, clinical presentations of persisted symptoms were triggered in numerous recently recovered COVID-19 patients, which led to the formulation of the novel term "post-COVID19 syndrome". Manifestations related to post-COVID-19 syndrome exist among approximately 50-80% of symptomatic COVID-19 patients who recovered, and among patients reported more than 50 different long-term effects of the SARS-CoV-2 infection. Many of the common symptoms of the post-COVID19 syndrome are not explained by the virus-related injury alone. Similarly to chronic fatigue syndrome and fibromyalgia, autoimmune-mediated autonomic nervous system dysfunction may play a significant part in the pathogenesis of such symptoms, including chronic fatigue, cognitive impairment, mood related disorders, and numerous more. Importantly, therapeutic options such as immunomodulatory and immunosuppressive therapy may favor some post-COVID19 patients, while plasmapheresis and IVIG could be considered in severe cases. Nevertheless, as physical exercise has been found to stabilize the autonomic nervous system, exercise therapy might be a safer and more effective remedy for the post-COVID19 syndrome.

Keywords: Autoimmune disease; Autoimmunity; Autonomic nervous system dysfunction; COVID-19; Chronic fatigue syndrome; Dysautonomia; Fibromyalgia; Long COVID-19; Post-COVID19 syndrome.

Fig. 1

In the center appears the SARS-CoV-2. Around it, at the upper part of the figure, appear some of the functionally active autoantibodies linked to COVID-19. At the bottom part of the figure appear some of the chronic symptoms associated with COVID-19. AGTR1: Angiotensin II Receptor Type 1; AGTR2: Angiotensin II Receptor Type 2; BDKRB1: Bradykinin Receptor B1; MAS1: MAS1 Proto-Oncogene; CXCR3: C-X-C Motif Chemokine Receptor 3; CHRM2: Cholinergic Receptor Muscarinic 2; CHRM3: Cholinergic Receptor Muscarinic 3; CHRM5: Cholinergic Receptor Muscarinic 5; F2R: Coagulation Factor II Thrombin Receptor; NOR: nociception-like opioid receptor; ADRB1: Adrenergic receptor beta-1; ADRB2: Adrenergic receptor beta-2; ADRA1: Adrenoceptor Alpha 1A; NRP1: Neuropilin 1; STAB1: Stabilin 1; ETA: Selective endothelin-A.